Thursday, October 25, 2012

Halloween Alert: Gum can be poisonous

Xylitol Toxicosis

Contributors:
Linda G. Shell, DVM, ACVIM (Neurology)

Synonyms:
Chewing gum toxicosis
Chewing gum poisoning
Xylitol poisoning

Disease description:
Pure xylitol is a white crystalline substance that looks and tastes like sugar. On food labels, xylitol is classified broadly as a carbohydrate and more narrowly as a polyol. It has been used as a sugar substitute and can be found in sugar-free candy, gums and other products. In humans, xylitol has little to no effect on plasma insulin or glucose levels, but in dogs xylitol is a strong promoter of insulin release and can cause severe hypoglycemia with ataxia, collapse and seizures. Hypokalemia can be present and is likely due to potassium shift (insulin drives potassium into the cells). Xylitol can also cause hepatic necrosis and death. 1,3-5

HOW MUCH XYLITOL CAUSES TOXICITY?  Chewing gums that are largely or only sweetened with xylitol contain about 1-2 grams/piece. Thus one or two pieces of gum could cause hypoglycemia in a 10 kg dog. 4

HEPATIC INJURY Some dogs develop elevated liver enzymes 8-12 hours post-xylitol ingestion and recover fully. Others develop acute liver failure, hemorrhage, and disseminated intravascular coagulation and often die. The lowest dose to cause hepatic necrosis is thought to be 1.6-2 g/kg. Most of the dogs who developed acute hepatic failure and DIC actually did not apparently show signs of hypoglycemia after ingestion of xylitol. 3 Further observations suggested that these cases became acutely ill about 48 hours post xylitol ingestion and had extremely elevated ALTs (often not measurable), elevated bilirubin, and prolonged PT/PTTs. In some cases of hepatic necrosis, hypophosphatemia was found initially but was followed by hyperphosphatemia in the terminal stages. Symptoms include:
Loss of appetite
Fluid in the abdomen
Stagering, incoordination/unable to stand
weight loss
diarrhea/vomiting
Nose bleed
Low body temp (normal is 102 rectally)
drinking/urinating a lot
Yellow skin or whites of the eye
bruising

BEHAVIOR CHANGE
 aggression

CENTRAL NERVOUS SYSTEM (CNS) SIGNS
Coma, unconsciousness
Convulsions, seizures


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